Abdominal extragenital endometriosis: single centre experience

WOS: 000437950900019Purpose: This study aimed to present our clinical experience on symptomatic intaabdominal extragenital endometriosis cases. Materials and Methods: In this study, patients undergoing surgery various indications and for which final histopathologic results reported as endometriosis were evaluated. Demographic characteristics, clinical presentations, localization of disease, surgical procedures and recurrence rates within follow-up period were presented. Results: Histopathologically confirmed 778 endometriosis patients were retrospectively analyzed. Extragenital abdominal endometriosis were present in 32 (4.1%) patients and all cases were symptomatic. The most common symptoms at index admission were mass detected within abdominal wall (n: 13; 40.6%) and chronic recurrence abdominal/pelvic pain (n: 9, 28.1%). 22% (n=7) of patients with abdominal extragenital endometriosis were diagnosed preoperatively. The operations performed were as follows: mass excision from the abdominal wall (n=14, 43.8%), appendectomy (n=5, 15.7%), pelvic mass excision(n=6, 18.8%), anterior resection (n=3, 9.4%), right hemicolectomy (n=2, 6,3%), and laparotomy with urinary stenting (n=2, 6,3%). Recurrence is reported in 6 (18.7%) cases at median follow-up of 42 months. Conclusion: Due to extragenital involvement, endometriosis should be part of differential diagnosis in all women who are reserved for abdominal surgery during reproductive era. Along with the complete excision, wound protector use can potentially decrease recurrence rates in cases diagnosed pre- or intraoperatively as endometriosis

A case of hepatolithiasis mimicking tumor

WOS: 000437950900036

18F-FDG activitiy PET/CT and CA-19.9 levels for the prediction of histopathological features and localization of peri- ampullary tumors

Background/Aims: We sought to investigate the roles of maximum standardized uptake value (SUVmax) and serum carbohydrate antigen 19-9 in predicting the histopathological features of periampullary tumors. Materials and Methods: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUVmax was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUVmaxand CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors.Results: 18F-FDG PET/CT SUVmax (=2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUVmax were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter.Conclusion: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUVmax and CA 19-9 levels.Background/Aims: We sought to investigate the roles of maximum standardized uptake value (SUVmax) and serum carbohydrate antigen 19-9 in predicting the histopathological features of periampullary tumors. Materials and Methods: Thirty-four patients with histologically confirmed periampullary tumors were classified into two groups, according to the localizations of their tumors (ampulla Vateri or pancreas). SUVmax was obtained from [(18)F]-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT). SUVmaxand CA 19-9 levels were measured and compared with histopathological features of the tumors. Logistic regression was used to assess the significance and independence of predictive factors.Results: 18F-FDG PET/CT SUVmax (=2.5; p=0.031) and CA 19-9 level (normal vs. elevated; p=0.045) were significantly and independently predictive of the histopathological origin of the tumors (ampulla Vateri vs. pancreas). The ratio of CA 19-9 levels and SUVmax were found to be higher in cases of poorly differentiated tumors and tumors greater than 2 cm in diameter.Conclusion: A surgical approach to treatment may be considered for patients who have both i) an established or suspected diagnosis of periampullary tumors and ii) low SUVmax and CA 19-9 levels

Hepatik Alveolar Ekinokokkoz Cerrahisinde Zorluklar, Prognoz ve Yönetim: Tek Merkez Deneyimi

Giriş: Alveolar ekinokokkoz (AE) primer olarak karaciğeri etkileyen ve tümör benzeri davranış gösteren, agresif ve potansiyel olarak fatal bir infeksiyondur. Bu infeksiyon için cerrahi prosedürlere ilişkin sonuçlar nadiren raporlanmıştır. Bu çalışmada hepatik AE'in cerrahi tedavisi ile ilişkili olarak uzun dönem sonuçları değerlendirmeyi amaçladık. Yöntemler: 2001 ve 2013 yılları arasında, metastaz durumuna bakılmaksızın hepatik AE nedeniyle komplet rezeksiyon için uygun bulunan hastaların yönetimi ve sonuçları tanımlandı. Tüm hastaların preoperatif AE tanısı klinik bulgular, görüntüleme teknikleri ve serolojik testelere göre konuldu. Echinococcus multilocularis metasestod antijenine karşı oluşan antikor düzeyleri, Western Blot tekniğiyle elde edilen AE serolojik tanısı için spesifik markırlarlar olarak kullanıldı. Oral albendazol protokolü komplet rezeksiyonun yapılabildiği tüm hastalara uygulandı. Bulgular: Çalışma periyodu boyunca patolojik olarak hepatik AE olduğu konfirme edilen 12 hastaya (K/E=7/5) komplet rezeksiyon uygulandı. Ortanca takip süresi 82 ay idi. En sık başlangıç semptomları karın ağrısı (n=9) ve sarılık (n=4) idi. Beyin, sürrenal, dalak ve kolon olmak üzere 4 hastada metastaz tespit edildi. Alınan uygun önlemlere karşın bir hastada mortalite gözlenirken, gelişen diğer komplikasyonların tamamı başarı ile tedavi edildi. Sonuç: İleri evre hepatik AE olgularında uzun dönemdeki olumlu sonuçlar, komplet cerrahi rezeksiyon ile birlikte yapılan Albendazol uygulaması ile elde edilebilir.Objective: Alveolar echinococcosis (AE) is an aggressive and potentially fatal infection, which affects the liver primarily and presents as a tumor-like lesion. Outcomes associated with surgical procedures for this infection have been rarely reported. In the present study, we aimed to evaluate long-term surgical treatment outcomes associated with hepatic AE. Methods: Between 2001 and 2013, the management and outcomes of twelve consecutive hepatic AE patients who were considered feasible for complete hepatic resection with/without metastasectomy were described. In all patients, pre-operative diagnosis of AE was based on clinical findings, imaging studies, and serological tests. Antibodies against antigens of Echinococcus multilocularis metacestodes were screened as specific markers for the serological diagnosis of AE by Western blot. The oral albendazole protocol was administered for hepatic AE patients who had complete resection. Results: Twelve patients (F/M=7/5) underwent complete resection for pathologically confirmed hepatic AE during the study period. Median follow-up was 82 months. The most common initial symptom was abdominal pain (n=9) followed by jaundice (n=4). Four patients had metastasis: Brain, surrenal, splenic and colon. One patient was lost due to massive pulmonary emboli despite appropriate interventions. All other complications that emerged were treated successfully. Conclusion: Long-term favorable outcomes can be achieved by complete surgical resection followed by chemotherapy with albendazole in advanced hepatic AE case

Macroscopic Portal Vein Thrombosis in HCC Patients

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumormultifocality. A logistic regressionmodel that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD >5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development